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Around 40,000 residents of Pakistan's Tirah Valley, close to the border with Afghanistan, have fled their homes after renewed fighting in the last few weeks, according to the Disaster Management Authority in the Federally Administered Tribal Areas (FDMA).

Most of the refugees from the Khyber Agency are heading towards Kohat, Hangu and Peshawar districts in Khyber Pakhtunkhwa (KP) Province or to the Kurram Agency in the tribal belt.

"My wife, my elderly mother and my two brothers walked for over 14 hours to reach safety," said Abdullah Khan, 30. He is now staying with relatives in Peshawar.

He said his wife, seven months pregnant, was "suffering severe stomach cramps." He and his brothers had carried their mother until they found a truck to give them a lift, as "she is quite frail and unable to walk for more than 30 minutes or so".

Aid agencies have given similarly harrowing accounts. The Norwegian Refugee Council (NRC) said many had walked for hours "without any access to basic services, such as shelter and water".

The government provided some transport to those fleeing.

"People have suffered tremendously, escaping the violence and struggling for their lives. Most of them left their homes and their livelihood behind without being able to bring any belongings but the bare minimum to sustain the journey out of the valley," said Saeed Ullah Khan, country director of NRC.

Escalating hostilities

According to the Geneva-based Internal Displacement Monitoring Centre, some 750,000 persons are already internally displaced in Pakistan due to conflict and natural disasters.

The "escalation of hostilities in [the] Bagh Maidan area of Tirah Valley in Khyber Agency has resulted in the displacement of over 5,200 families (40,600 individuals). The displacements started mid-last week. Most of the IDPs [internally displaced people] are children (46 per cent) and women (32 per cent)," according to an update by the UN's Office for the Coordination of Humanitarian Affairs (OCHA), citing information from the FDMA.

Fighting between government soldiers and militants in Tirah Valley, which has strategically important routes into Afghanistan, has been underway for several months, but intensified recently with militants seizing control of key areas.

"We have received no help at all, and don't know what to do. We could bring nothing with us, and have no clothing, food, documents or cash"

The conflict is a complicated one, involving at least three militant groups that also have internal divisions.

The humanitarian community is setting up operations to register the 40,000 IDPs and provide assistance at the New Durrani, Jalozai and Togh Sarai IDP camps, said Jean-Luc Siblot, the Acting Humanitarian Coordinator for aid agencies in Pakistan and the World Food Programme's country representative.

"Expectations are that the caseload is likely to grow and for tensions to continue. Agencies are monitoring the situation closely", he said.

Security concerns hamper aid

Those fleeing have not always ended up in safer places. A car bomb blast at a food distribution point at the Jalozai Camp last week left 17 dead and many others injured.

The district police officer, Muhammad Hussain, told IRIN, "We believe the blast may have been carried out by militants targeting tribespeople who opposed them and fled their villages as they moved in to capture these areas."

The security threat is making it more difficult for humanitarian groups to provide aid.

"The humanitarian community is monitoring the situation and stands ready to start humanitarian assistance to the IDPs as soon as the government puts in place the security mitigation measures," said the OCHA update.

IDPs, meanwhile, continue to struggle.

"We have received no help at all, and don't know what to do. We could bring nothing with us, and have no clothing, food, documents or cash," said Abdullah Khan, who is also trying to seek urgent medical attention for his ailing wife and work out what to do next.